Min Sugi, Gillani Fizza S, Aung Su, Garland Joseph M, Beckwith Curt G
The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
The Miriam Hospital, Providence, Rhode Island, USA.
Open Forum Infect Dis. 2020 Nov 16;7(12):ofaa529. doi: 10.1093/ofid/ofaa529. eCollection 2020 Dec.
Studies have demonstrated that persons with HIV (PWH) maintaining viral suppression do not transmit HIV to HIV-negative partners through condomless sex, leading to the "Undetectable = Untransmittable (U = U)" prevention campaign. However, few studies have examined the durability of suppression in the era of U = U.
This retrospective cohort study was conducted in Providence, Rhode Island. PWH aged ≥18 years with documented viral suppression (defined as at least 1 viral load [VL] <200 copies/mL and no VL ≥200 copies/mL) in 2015 were included in the baseline cohort. Primary outcomes were viral suppression, viral rebound (at least 1 VL ≥200 copies/mL), or gap in VL monitoring assessed annually from 2016 to 2019. Those with viral rebound were assessed for resuppression within 6 months. Demographic and clinical characteristics associated with viral rebound or gaps in VL monitoring were investigated by bivariate analysis and logistic regression.
A total of 1242 patients with viral suppression were included in the baseline cohort. In each follow-up year, 85%-90% maintained viral suppression, 2%-5% experienced viral rebound, and 8%-10% had a gap in VL monitoring. Among those with viral rebound, approximately one-half were suppressed again within 6 months. In the logistic regression models, retention in care was significantly associated with viral suppression, while younger age, black race, high school or equivalent education, non-men who have sex with men, and history of incarceration were significantly associated with viral rebound.
In the U = U era, most patients with viral suppression who are retained in care are likely to maintain viral suppression over time. Some patients require additional support for regular VL monitoring.
研究表明，维持病毒抑制的HIV感染者（PWH）不会通过无保护性行为将HIV传播给HIV阴性伴侣，由此产生了“检测不到=不具传染性（U=U）”的预防运动。然而，很少有研究探讨U=U时代病毒抑制的持久性。
这项回顾性队列研究在罗德岛州普罗维登斯进行。2015年有记录显示病毒得到抑制（定义为至少1次病毒载量[VL]<200拷贝/毫升且无VL≥200拷贝/毫升）的18岁及以上PWH被纳入基线队列。主要结局为病毒抑制、病毒反弹（至少1次VL≥200拷贝/毫升）或2016年至2019年每年评估的VL监测缺口。对出现病毒反弹的患者在6个月内进行重新抑制评估。通过双变量分析和逻辑回归研究与病毒反弹或VL监测缺口相关的人口统计学和临床特征。
基线队列共纳入1242例病毒得到抑制的患者。在每个随访年度，85%-90%的患者维持病毒抑制，2%-5%的患者出现病毒反弹，8%-10%的患者存在VL监测缺口。在出现病毒反弹的患者中，约一半在6个月内再次得到抑制。在逻辑回归模型中，持续接受治疗与病毒抑制显著相关，而年龄较小、黑人种族、高中或同等学历、非男男性行为者以及有监禁史与病毒反弹显著相关。
在U=U时代，大多数持续接受治疗的病毒得到抑制的患者可能会长期维持病毒抑制。一些患者需要额外支持以进行定期VL监测。
